Lecture Images Flashcards
Note: no sensory distribution for C1
Winged scapula
(a) Muslce involved
(b) Nerve injured
Winged scapula due to injury to (b) Long thoracic causing loss of innervation to the (a) serratus anterior
SALT = serratus anterior, long thoracic
Nerve controlling
(a) Foot dorsiflexion
(b) Foot plantar flexion
(a) Dorsiflexion by the deep peroneal nerve
(b) Plantar flexion by the tibial nerve
What malignancy should be screened for in a pt w/ distal peripheral neuropathy w/o diabetes?
Screen for multiple myeloma
-also chronic alcoholism can cause stocking-and-glove distribution peripheral neuropathy
What are the two main branches fo the sciatic nerve?
Before going thru the popliteal fossa the sciatic nerve splits into the common peroneal/fibular nerve and the tibial nerve
The belt might cause injury to what nerve? How would this present?
Injury to lateral femoral cutaneous nerve
-tingling/numbness/burning in outer thigh
2/2 tight clothing, obesity/wt gain, pregnancy
Purpose of tPA
Save the penumbra- tissue that is ischemic but not yet infarcted
-takes 90 minutes on average to set up the IR suite => give tPA in the mean time to save penumbra
Baby pulled out of birth canal by arm is at risk for what?
Klumpke’s palsy (claw hand deformity) 2/2 damage to C8-T1
Name the 4 most common locations for white matter lesions in MS
- Periventricular
- look like Dawson’s fingers on sagittal view - Juxtacortical
- Infratentorial (posterior fossa)
- brainstem and cerebellum - spinal cord
Where may jaw pain radiate? Why?
Jaw pain sometimes radiates to the ear b/c both are of the C2 dermatome
Dx
Left ACA stroke
2 findings on MRI
Dx
Dx = neuromyelitis optica = Devic’s disease = simultaneous inflammation and demyelination of the optic nerve and spinal cord
- on a spectrum w/ MS
- inflammatory disease that presents w/ pathology of the optic nerve/chiasm
What nerve innervates the
(a) Quadriceps
(b) Hamstring
(c) Gluteus maximus
(a) Femoral nerve innervates the quadricep
(b) Sciatic nerve innervates the hamstring
(c) Inferior gluteal nerve innervates the gluteus maximus
Precentral vs. postcentral gyrus
Precental = primary motor cortex
Postcentral = primary sensory cortex
(a) Finding
(b) Dx
(a) Finding = juxtacortical lesion
(b) MS
48 yo POD1 from bifrontal meningioma removal, uncomplicated postop but now somnolent
(a) Dx
(b) Mgmt
(a) Dx = bitemporal tension pneumocephalus (air in the head)
(b) Mgmt = bed flat
- 100% oxygen to diffuse out the nitrogenous air
- needle decompression
- consider bifrontal craniectomy if need to
Name the two reflexes tested in the lower extremity
(a) What nerve roots innervate these reflexse?
- achilles innervated by S1/S2
- patellar reflex innervated by L3/L4
Pt cannot extend his leg at the knee- which nerve is injured?
Can’t extend knee = inability to control quadricep muscle = injury to femoral nerve
Baby pulled out of birth canal by head is at risk for what?
Erb’s palsy (waiter’s tip deformity) due to damage to C5-C6
Dermatomal landmarks
(a) Bellybutton
(b) Nipple line
(c) Thumb
(a) Bellybutton = T10
(b) Nipple line = T4
(c) Thumb = C6 (thumb’s up)
Injury to what nerve causes wrist drop
Injury to radial nerve which innervates the muscles that extend the wrist (extensor carpi ulnaris and radialis)
- ‘man falls asleep w/ arm under partner’
- ‘falls asleep w/ arm slung over the back of a chair’
Dx
Dx = MS plaque
-tissue showing discoloration in the white matter, indicating large area/amount of demyelination
(a) Dx
(b) Next step
(a) Dx = subarachnoid hemorrhage
- the dread star sign = blood in the circle of Willis
(b) Next step = CTA to find the aneurysm
What nerve innervates the
(a) Pec major
(b) Rhomboids
(a) Medial and lateral pectoral nerves innervate the pectoralis major
(b) Dorsal scapular nerve (Don’t Shoot Rhinos)
What is a tumefactive MS lesion?
Tumefactive lesion = atypical presentation of MS w/ large area of demyelination
-often mistaken as neoplasm or abscess
Shoulder shrug
(a) Muslce
(b) Nerve
Shoulder shrug
(a) Trapezius
(b) CN IX = accessory spinal nerve
Sargant’s patch = small area of skin w/ sensation provided by axillary nerve
Differentiate active vs. old MS lesions
Active lesions: hyperintense on MRI and often ring-enhanced w/ contrast (T1)
Old lesions appear hypointense, called ‘black holes’
-evidence of irreversible axonal damage
Pt w/ steppage gait- drag toes on the ground while walking
Injury to what nerve?
Steppage gait due to weakness in dorsiflexion (toes towards face) of the foot controled by the tibialis anterior innervate by the deep peroneal nerve
What nerve provides sensation to the genital region?
Pudendal nerve (hence pudendal nerve block in child birth)
Sensation to the thumb
Palmar surface by median nerve
Dorsal surface by radial nerve
What nerve controls
(a) Supination of the hand
(b) Pronation of the hand
It’s SUPer RAD to be PreMed
(a) Supination of the hand (palm up to ceiling) by radial nerve
(b) Pronation of the hand (palm to hand) by median nerve
What nerve
(a) Flexes the biceps
(b) Flexes the tricep
(a) Musculocutaneous nerve
(a) Radial nerve
What nerve innervates the diaphragm?
(a) Comes from what nerve roots?
Phrenic nerve from C3,4,5
C3,4 and 5 keep you breathing and a live
Differentiate Kussmal and Cheyne-Stokes breathing
Kussmal breathing = deep and labored breaking associated w/ severe metabolic acidosis seen in DKA and kidney failure
-slow, deep breaths
Cheyne-stokes breathing = fluctuations btwn hyperapnic and apneic episodes
-associated w/ hypoperfusion to respiratory center (ex: herniation)
S/p falling off bike- shooting pain from neck down to thumb
-decreased sensation to thumb, decreased bicep reflex, weakness of bicep muscle
Locate the injury
Injury = C6 nerve root
From neck to thumb = has to be central (not peripheral)
- thumb sensation = both median and radial
- bicep reflex = C5/C6
- bicep muscle = musculocutaneous nerve (C5/C6)
Dx?
Finding = cortical ribboning
-indicative of spontaneous Creutzfeldt-Jakob Disease (dismal prognosis)
Course of disease in MS
(a) Typical
(b) Atypical
Course of disease in MS
(a) 85% have relapsing and remitting course: disease doesn’t progress independently of attacks
- progresses to secondary progressive phase
(b) Atypical: 10% have primary progressive disease where it is progressive at the onset w/o clear relapses
S/p unsuccessful clot retrieval for MCA stroke, MRI shows:
What are you worried about?
Worried about herniation! Edema/increased ICP causing herniation
edema 2/2 dysfunction of Na/K pumps (2/2 ischemia)
Characteritic finding of active MS lesion on MRI w/ contrast
T1 w/ constrat of active MS lesion: shows enhancement/hyperintensity (2/2 BBB breakdown) characteristically w/ incomplete ring, often w/ the opening of the ring pointing to the cortex
Name the types of herniation
- Uncal (transtentorial)
- Central
- Subfalcine
- Extracranial
- Uptward (transtentorial)
- Tonsilar
Biceps reflex = C5
Brachioradialis = C6
Triceps reflex = C7
Hit your elbow on the end of a coffee table, what hand findings might you have?
Ulnar nerve runs around the posterior aspect of the medial epicondyle of the humerus thru the cubital tunnel => susceptible to injury when you bang your funny bone
-ulnar nerve injury => numbness to pink and ring finger, cannot make a tight fist
(a) Finding
(b) Diagnosis
(a) Dawson’s fingers of periventricular MS lesions
(b) Dx = MS
